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Neutrophil to Lymphocyte Ratio and Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis Publisher Pubmed



Salimi M1 ; Karam JA2 ; Willman M3 ; Willman J3 ; Luckewold B4 ; Khanzadeh S5 ; Mirghaderi P6 ; Parvizi J7
Authors
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Authors Affiliations
  1. 1. Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  2. 2. Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois, United States
  3. 3. University of Florida, Gainesville, FL, United States
  4. 4. Department of Neurosurgery, University of Florida, Gainesville, FL, United States
  5. 5. Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
  6. 6. Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Source: Journal of Arthroplasty Published:2024


Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) has shown promising results as a diagnostic tool for periprosthetic joint infection (PJI) after total joint arthroplasty. We conducted a systematic review and meta-analysis to determine the utility of NLR in the diagnosis of PJI. Methods: We searched PubMed, Scopus, and Web of Science from inception up to 2022 and evaluated the quality of the included literature. Results: Based on the 12 eligible studies, NLR levels were significantly higher in patients who had PJI compared to those who had aseptic loosening (standard mean difference (SMD) = 1.05, 95% Confidence Interval (CI) = 0.71 to 1.40, P < .001). In the subgroup analysis according to type of PJI, NLR levels were significantly higher in patients who had either acute (SMD = 1.04, 95% CI = 0.05 to 2.03, P < .001) or chronic PJI (SMD = 1.08, 95% CI = 0.55 to 1.61, P < .001), compared to those who had aseptic loosening. According to type of arthroplasty, NLR levels were significantly higher in patients who had either total knee arthroplasty (SMD = 1.81, 95% CI = 1.48 to 2.13, P < .001) or total hip arthroplasty (SMD = 1.76, 95% CI = 1.54 to 1.98, P < .001) compared to aseptic loosening. The pooled sensitivity of the 12 studies was 0.73 (95% CI, 0.65 to 0.79), and the pooled specificity was 0.75 (95% CI, 0.71 to 0.78). The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of NLR were 2.94 (95% CI = 2.44 to 3.54), 0.35 (95% CI = 0.27 to 0.46), and 8.26 (95% CI = 5.42 to 12.58), respectively. Conclusion: In summary, this meta-analysis indicates that NLR is a reliable marker in the diagnosis of PJI. © 2023
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